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Details of Fukushima Thyroid Cancer Surgical Cases

This is a compilation of the most current information
on Fukushima thyroid cancer surgical cases from 3 different sources (screenshots of the abstracts for 2 & 3 can be seen in this post):

November
11, 2014Thyroid Examination
Evaluation Subcommittee meeting

November 14, 2014 Japan Thyroid Association
meeting

August 28, 2014 Japan Society of Clinical Oncology meeting

Due to
the span of the time amongst these 3 sources, they have different numbers for
the cases of thyroid cancer. For clarification, the most updated summary of the
thyroid cancer cases is presented first.

Three years have passed since the disaster struck. Of
1,848 subjects that underwent the secondary examination up to June 30, 2014, 485 had
cytological examinations. Suspicious or malignant cases totaled 104, and 58 of
them were already operated on.

Surgeries on 55 of 58 cases were conducted at the
Division of Thyroid and Endocrine Surgery, Fukushima Medical University. 3
cases were operated on at other facilities. As 1 of 55 cases turned out to be
benign nodule post-operatively, only the 54 thyroid cancer cases were
considered there.

According to the pathological evaluation, 52 cases
were papillary cancer, and 2 were poorly differentiated thyroid cancer.

Of these 9 cases, 7 were suspected to be close to the
trachea or the recurrent laryngeal nerve, or have extrathyroidal extension. The
remaining 2 cases were operated on based on patients’ wishes, despite the
recommendation of non-surgical follow-up.

Surgical methods included total thyroidectomy in 5
cases (9%), and hemithyroidectomy in 49 cases (91%). Lymph node dissection was
conducted in all cases, with 67% limited to the central compartment and 33%
including lateral compartment. As much as possible, small-size incisions of 3
cm were used.

There has been an increase
in the number of pediatric and young adult patients diagnosed with thyroid
cancer due to the advance in diagnostic ultrasound technology and
implementation of pediatric thyroid ultrasound screening. However, pathogenesis
relating to initiation and development of these cancers is yet to be fully
understood. Asit is anticipated the
number of cases will increase in the future, we will identify gene clusters
related to cancer initiation and elucidate the mechanism of pathogenesis in
order to reveal biological features of these cancers. In this study, we
investigated the gene clusters known to be related to thyroid cancer
initiation.

Study subjects: 24 surgical
cases (male:female = 1:2, average age 17.9 years (9-22 years)) in children and
young adults. 23 cases were papillary thyroid cancer and 1 was follicular
cancer. (Note: The actual presentation
referred to 23 cases of papillary thyroid cancer and 1 case of poorly
differentiated thyroid cancer).

Method: DNA and RNA were
extracted from excised tumor tissues and analyzed with direct sequencing and
PT-PCR. Mutation in BRAF, K-, N-, and H-RAS and rearrangement in RET/PTC1 and
RET/PTC3 were investigated.

Results: 67% was positive
for BRAF mutation. Also, 12.5 % had rearrangement of RET/PTC1, but no mutation
was found in RET/PTC3, K-, N-, and H-RAS.

Information
from the transcript of the presentation by Shinichi Suzuki

Five all-negative cases
included 1 case of follicular variant papillary thyroid cancer, 1 case of
poorly-differentiated cancer, and 3 cases of cribriform-morular variant
papillary thyroid cancer (CMVPTC). CMVPTC cases are under investigation for APC
genetic mutations which are known to be causative. All 3 CMVPTC cases have
family history.

Five all-negative cases had
slightly larger tumor diameter than others. These 5 cases were the only cases
undergoing total thyroidectomy.

BRAF positive cases are said
to be aggressive. RET/PTC1 tends to be seen in older children and associated
with cases unrelated to radiation exposure. RET/PTC3 is seen in younger
children, and seen frequently in Chernobyl, although it is not considered to be
the definitive oncogene for radiation-induced PTC. It is commonly thought gene
rearrangements are more frequently seen in children, whereas point mutations
are seen more in adults.

As a conclusion, BRAF, the
genetic mutation detected most frequently, is what is usually seen in typical
adult PTC. It is highly possible that cases which may not have been detected if
it weren’t for the thyroid ultrasound screening are being discovered in
children and young adults as a result of the screening.

Note 1: Three cases of cribriform-morular variant
papillary thyroid cancer are not consistent with the information from the
August 2014 meeting of Japan Society of Clinical Oncology below, showing 3
cases of diffuse sclerosing variant papillary thyroid cancer. It is likely the
pathological diagnosis was updated after an outside review.

Note 2: Suzuki’s presentation of these details
outside the Thyroid Examination Evaluation Subcommittee, especially before the
information was shared with the Subcommittee and the public, created
controversy as to the handling of data. Suzuki claims the study was accepted by
the ethics committee at Fukushima Medical University, but the thyroid
examination itself is conducted with the money provided by the central
government to Fukushima Prefecture, and the data belongs to the prefecture and
the residents. Suzuki has a track record of not revealing the data to the
Thyroid Examination Evaluation Subcommittee or the Prefectural Oversight
Committee for Fukushima Health Management Survey before presenting it at an
academic meeting in August 2014, as described below.

Note 3: This meeting was
closed to media due to the decision of the conference chair, based on the
wishes of some of the presenters.

Note 4: Shigenobu Nagataki, a mentor to Shinichi Yamashita, revealed the following information during the questions and answers session:

He
was asked by thyroid specialists attending the meeting if nodule sizes were the
only thing determined in this unprecedented, large-scale screening.
Participants wanted to know how many had Graves’ disease, autoimmune
thyroiditis, goiter, etc. [Note: Fukushima Health Management Survey has not released
hardly any data regarding non-cancer thyroid diseases]. Nagataki referred to
patient privacy in disclosing such information, but he was told patient privacy
meant such things as patients’ names and had nothing to do with how many
patients had Graves’ disease. [Note: Fukushima Medical University cites patient privacy when refusing to disclose details of their findings]. They asked him there must be a rough estimate of non-cancer thyroid diseases made by thyroid specialists conducting
ultrasound screening. Nagataki told them he would get back to them in
writing as he didn’t know what to say.

*****

The 52nd
Annual Meeting of Japan Society of Clinical Oncology

August
28-30, 2014

Organ
Specific Symposium 03, August 28, 201410:00-12:00

OS3-5 “Treatment of Pediatric Thyroid Cancer in Fukushima”

Shinichi Suzuki

Division of Thyroid and
Endocrinology, School of Medicine, Fukushima Medical University

Pediatric thyroid cancer has
been considered rare, consisting approximately 1-2% of all thyroid cancer. They
might appear to be advanced at first sight, with lung metastasis or widespread
lymph node metastasis discovered at the time of diagnosis, but long-term
survive is known to be extremely good.

After the Fukushima Daiichi
nuclear power plant accident following the Great East Japan earthquake and
tsunami on March 11, 2011, Fukushima Prefecture was burdened with the prospect
of faces long-term radiation health effects. Fukushima Health Management Survey
was launched in Fukushima Prefecture, with one of the surveys being thyroid
ultrasound examination of residents who were children at the time of the
accident. Initial Screening has already completed, and thyroid cancer cases
have been discovered. We report our experience in treating these asymptomatic
pediatric thyroid cancers detected through ultrasound screening, unlike the
usual symptomatic thyroid cancer.

Study subjects are 269,354
children (participation rate 80.8%) who underwent primary examination from
October 2011 to December 31, 2013. Of these, 1796 required secondary
examination, and 75 of them were diagnosed with malignant or suspicious tumor
as a result of fine-needle aspirational biopsy. 34 already had surgery, and 33
were confirmed to have thyroid cancer. We are reporting here on the 31 cases
operated on in our department.

Average age at the time of
surgery is 16.4 (9-20) years,the male
to female ratio is 14:17, and 9 cases were from Fiscal Year 2011 (from 13
municipalities designated by the government to be evacuation zone), and 22
cases were from Fiscal Year 2012.

In all cases, intraoperative
monitoring of the recurrent laryngeal nerve was conducted using NIM. Surgical
incision for neck dissection was limited to small skin incisions of 3 cm in the
central compartment dissection and 3-5 cm in the lateral compartment
dissection. No paralysis of the recurrent laryngeal nerve or hypoparathyroidism
was observed.

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